Idiopathic toe-walking: have we progressed in our knowledge of the causality and treatment of this gait type?

Background: Idiopathic toe-walking (ITW) is a condition commonly seen by podiatric physicians. Because a toe-walking gait style is also caused by or associated with many other medical conditions, podiatric physicians should pay particular attention to ensuring an accurate diagnosis. There are many reported treatment options available for ITW. Therefore, a literature review was conducted to determine what treatment options are supported by the evidence as having the best long-term effect on ITW gait. Methods: After extraction of relevant articles, 21 manuscripts reporting treatment options for ITW gait were appraised against the levels of evidence. Results: From these articles, there was no single treatment option reported as having a long-term effect on the gait of children with ITW. There was support in the literature for surgical interventions, serial casting, and the use of botulinum toxin type A. There was limited evidence that footwear or orthoses changed the gait pattern. Conclusions: This review updates the knowledge of podiatric physicians, enhances how children who present with this gait style can be managed, and highlights areas for future research.